General
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● Clinical staging is based on bimanual examination under anesthesia, imaging, biochemical and isotopic tests for metastases
● Pathologic staging is based on review of TURBT (transurethral resection of bladder tumor), partial cystectomy or radical cystectomy specimens
● Pathological stage is the most important determinant of treatment and prognosis for bladder cancer (Cancer 2000;88:2326)
● Lamina propria invasion may be difficult to determine due to fragmentation, cautery, tangential sectioning and poorly oriented specimens
● Muscularis propria invasion can be difficult to determine if there are insufficient muscle bundles to distinguish between hypertrophic muscularis mucosae and true muscularis propria
An accurate pathological stage can be assigned to TURBO (transurethral resection in one piece) specimens in most bladder cancer patients (Int J Urol 2010;17:708)

● T4 disease includes prostatic stromal invasion directly from bladder cancer, but does not include subepithelial invasion of prostatic urethra
● Common iliac nodes are defined as regional nodes (secondary drainage region) and not metastatic disease
● N staging has been changed as indicated below (size is no longer relevant)
● Tumors are graded with the low grade / high grade designation of the WHO/ISUP, replacing the previous 3 and 4 four grade systems

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